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Pharm for Sinusitis and the Oropharynx
Terms in this set (50)
Strep pneumoniae, H influenzae, M catarrhalis, S aureus
what are the most common causes of bacterial sinusitis?
7 days, 3 days
how long of an observation period can you do before prescribing antibiotics in adults with bacterial sinusitis? in children?
worsening illness, severe onset, abx in last 4 weeks, concurrent infection, or underlying conditions
when should an antibiotic be prescribed immediately for bacterial sinusitis?
amoxicillin or a standard dose amoxicillin/clavulanic acid
what is the first line treatment for bacterial sinusitis in adults without risk factors for pneumococcal resistance?
high dose amoxicillin/clavulanic acid
what is the first line treatment for bacterial sinusitis in adults with risk factors for pneumococcal resistance (recent abx treatment) or when there is high risk for poor outcome?
doxycycline or third gen cephalosporin plus clindamycin
what is the first line treatment for bacterial sinusitis in adults with penicillin allergies?
standard dose amoxicillin/clavulanic acid
what is the first line treatment for bacterial sinusitis in children with no risk factors for resistance?
high dose amoxicillin/clavulanic acid
what is the first line treatment for bacterial sinusitis in children in areas with high rates of S. pneumoniae resistance?
third gen cephalosporin (Cefpodoxime has greater activity against H. influenza), levofloxacin (if there are no other safe options), or IM ceftriaxone (if NPO or vomiting)
what are the alternative treatments for bacterial sinusitis in children?
levofloxacin for type 1 or 4, cefpodoxime or cefdinir for mild or delayed reaction
what are the first line treatments for bacterial sinusitis in children with penicillin allergies?
5-7 days, 10-14 days
what is the duration of treatment for bacterial sinusitis in adults? in children?
worse after 2-3 days, not improving after 3-5 days
for a bacterial sinusitis patients, when should you consider a change in their antibiotic therapy?
acetaminophen or NSAIDs, INGC (can cause candidiasis)
besides antibiotics, what medications can bacterial sinusitis patients use to help with their symptoms?
CRS w/o nasal polyps, CRS w/nasal polyps, allergic fungal rhinosinusitis
what are the 3 subtypes of chronic rhinosinusitis (CRS)?
intranasal saline irrigation or saline nasal spray, INGC
what is the recommended initial therapy for CRS without nasal polyps?
2-4 weeks systemic antibiotics (amoxicillin/clavulanic acid, clindamycin, moxifloxacin), 10-15 days glucocorticoids
if the initial therapy for CRS without nasal polyps is not effective, what can you try?
INGC spray, intranasal saline spray, treat underlying rhinitis if present, antileukotriene agents (refractory congestion and postnasal drainage), avoid chronic use of decongestants
what is the maintenance therapy for CRS w/o polyps?
oral glucocorticoids 10-15 days, 2-4 weeks antibiotics (if bacterial infection)
what are the initial therapies for adult CRS w/nasal polyps?
saline irrigation before INGC (xhance device), antileukotrienes, antihistamines for persistent cases, or dupilumab
what are the therapies for maintenance of CRS w/nasal polyps in adults?
inhibits signaling of IL-4 and IL-13, preventing the generation of inflammation mediated by T helper type 2 cells and inhibits eosinophil migration into tissues.
what is the mechanism of action of dupilumab?
infancy, antibiotic treatment, INGC, chemo, radiation, cellular immunodeficiency
what are the risk factors for oral candidiasis?
gram stain or KOH
what tests can you do to confirm a diagnosis of candidiasis?
Binds to sterols in fungal cell membrane, changing the cell wall permeability which allows the intracellular contents to leak out.
what is the mechanism of action of Nystatin?
Interferes with fungal cytochrome P450 activity (lanosterol 14-alpha-demethylase), decreasing ergosterol synthesis (principal sterol in fungal cell membrane) and inhibiting cell membrane formation
what is the mechanism of action of Azole derivatives: clotrimazole, miconazole, fluconazole?
what medication do you use for mild oral candidiasis in immunocompromised infants?
what medication do you use for mild oral candidiasis in neonates?
nystatin suspension 100,000 units to each cheek 4x daily for 7-14 days
what medication do you use for mild oral candidiasis in infants? include dosing?
nystatin suspension 400,000-600,000 units "swish and swallow" 4x daily for 7-14 days
what medication do you use for mild oral candidiasis in children? include dosing?
Clotrimazole troches, miconazole (mucoadhesive buccal) tablets, nystatin swish and swallow, oral fluconazole
what medications can be used for mild oral candidiasis in adults?
what medication can be used for refractory oral candidiasis in infants?
what medication can be used for moderate-severe oral candidiasis in children?
drink plenty of fluids, avoid physical contact with lesions, acetaminophen or ibuprofen, Abreva, home remedies (aloe vera gel, cornstarch paste, and tea or mint leaves)
what are the treatments for mild, uncomplicated oral herpes simplex?
topical anesthetics, oral and IV antivirals (valacyclovir, famciclovir, acyclovir), topical antiviral cream (acyclovir or penciclovir)
what are the treatments for more serious oral herpes simplex?
adenovirus, influenza, parainfluenza, rhinovirus, RSV
what are the most common viral causes of pharyngitis?
Group A Strep, Corynebacterium diphtheriae, N gonorrhoeae
what are the most common causes of bacterial pharyngitis?
sore throat, pharyngeal edema, and fever
what is the characteristic triad of symptoms for pharyngitis?
caused by Group A strep
when should abx be used to treat pharyngitis?
penicillin VK tablets, Benzathine penicillin G, amoxicillin
what are the antibiotic treatments for pharyngitis?
first gen cephalosporin
what is the antibiotic treatment for pharyngitis in patients with a non type I penicillin allergy?
clindamycin, clarithromycin, azithromycin
what are the antibiotic treatments for pharyngitis in patients with a type I penicillin allergy?
acetaminophen or an NSAID, avoid aspirin in children, hydration, salt water gargles, lozenges, supportive care with antihistamines, cough suppressants, and decongestants
what are the adjunctive therapies for pharyngitis?
drink fluid, avoid coffee, alcohol, tobacco and cannabis smoke, avoid mouth breathing, use humidifiers
what can patients do to prevent dry mouth?
antidepressants, antihistamines, anticholinergics, diuretics, neuroleptics, clonidine
what medications can cause dry mouth?
artificial saliva, water spit and rinse, ice chips, add liquid omega-3 oil to water, mechanical and gustatory saliva stimulation, dental care and oral hygiene, sialagogues
what are the treatments for dry mouth?
sugar free hard candies or lozenges or gum, xylitol gum or candy, citrus flavored tablets or oral drops, maltose lozenges, dried peach or nectarine slices
what can patients use for mechanical or gustatory stimulation of saliva in the treatment of dry mouth?
pilocarpine tablet or cevimeline capsule
what sialagogues can patients use to treat dry mouth?
what kind of medication is pilocarpine?
flushing, chills, dizziness, headache, nausea, urinary frequency, rhinitis, diaphoresis
what are the ADRs of pilocarpine?
good oral hygiene, avoid exacerbating factors, pain control
what are the treatments for aphthous ulcers?
topical lidocaine, antihistamine, dyclonine lozenges, antacid, attapulgite (absorbent clay)
what are the pain control options for aphthous ulcers?
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